Adenoiditis physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with adenoiditis are usually good-appearing. Physical examination of patients with adenoiditis is usually remarkable for fever, and purulent nasal discharges.<ref name="pmid25950686">{{cite journal |vauthors=Kosikowska U, Korona-Głowniak I, Niedzielski A, Malm A |title=Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production |journal=Medicine (Baltimore) |volume=94 |issue=18 |pages=e799 |year=2015 |pmid=25950686 |pmc=4602522 |doi=10.1097/MD.0000000000000799 |url=}}</ref>


== Physical exam ==
== Physical exam ==


===Appearance of the Patient===
===Appearance of the Patient===
*Patient is usually well-appearing in early stages, but may be ill appearing if the complications and disease severity are present.
*Patient is usually good-appearing in early stages, but may be ill appearing if the complications and disease severity are present.
===Vital Signs===
===Vital Signs===
*Fever
*Fever
*[[Tachycardia]] can be present as a
*[[Tachycardia]] can be present as a
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachypnea]] can be present as a result of infection or pneumonia
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
===HEENT===
===HEENT===
*Abnormalities of the head/hair may include ___
*[[Otoscopy|Otoscopic]] examination of the ears may reveal the following signs indicative of concurrent otitis media:<ref name="pmid25213276">{{cite journal |vauthors=Rettig E, Tunkel DE |title=Contemporary concepts in management of acute otitis media in children |journal=Otolaryngol. Clin. North Am. |volume=47 |issue=5 |pages=651–72 |year=2014 |pmid=25213276 |pmc=4393005 |doi=10.1016/j.otc.2014.06.006 |url=}}</ref>
*Evidence of trauma
**[[Erythema]] of the [[middle ear]].
*Icteric sclera
**Presence of effusion.<ref name="pmid23346249">{{cite journal |vauthors=Parlea E, Georgescu M, Calarasu R |title=Tympanometry as a predictor factor in the evolution of otitis media with effusion |journal=J Med Life |volume=5 |issue=4 |pages=452–4 |year=2012 |pmid=23346249 |pmc=3539835 |doi= |url=}}</ref>
*[[Nystagmus]]
**Bulging of the [[tympanic membrane]] in otitis media with effusion.
*Extra-ocular movements may be abnormal
**Cloudy appearance of the [[tympanic membrane]].
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
**Immobility of the [[tympanic membrane]].
*Ophthalmoscopic exam may be abnormal with findings of ___
**[[Tympanic membrane]] perforation.
*Hearing acuity may be reduced
*[[Purulent]] exudate from nose can be present as a result of concurrent sinusitis
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*Facial tenderness can be present as a result of concurrent sinusitis
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
*Erythematous throat with tonsillar swelling, exudates, and/or petechiae
*[[Exudate]] from the ear canal
*Oral mucous may be dry with ulcers due to mouth breathing
*Tenderness upon palpation of the ear pinnae / tragus (anterior to ear canal)
*Inflamed nares / congested nares
*[[Purulent]] exudate from the nares
*Facial tenderness
*Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
===Neck===
===Neck===
*[[Jugular venous distension]]
*[[Lymphadenopathy]] of cervical nodes may be present due
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
===Lungs===
===Lungs===
*Asymmetric chest expansion / Decreased chest expansion
*Fine [[crackles]] upon auscultation of the lung due to concurrent pneumonia
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


==References==  
==References==  
{{Reflist|2}}
{{Reflist|2}}

Revision as of 20:08, 1 June 2017

Adenoiditis Microchapters

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Historical Perspective

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Physical Examination

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Future or Investigational Therapies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Patients with adenoiditis are usually good-appearing. Physical examination of patients with adenoiditis is usually remarkable for fever, and purulent nasal discharges.[1]

Physical exam

Appearance of the Patient

  • Patient is usually good-appearing in early stages, but may be ill appearing if the complications and disease severity are present.

Vital Signs

  • Fever
  • Tachycardia can be present as a
  • Tachypnea can be present as a result of infection or pneumonia

HEENT

  • Otoscopic examination of the ears may reveal the following signs indicative of concurrent otitis media:[2]
  • Purulent exudate from nose can be present as a result of concurrent sinusitis
  • Facial tenderness can be present as a result of concurrent sinusitis
  • Erythematous throat with tonsillar swelling, exudates, and/or petechiae
  • Oral mucous may be dry with ulcers due to mouth breathing

Neck

Lungs

  • Fine crackles upon auscultation of the lung due to concurrent pneumonia

References

  1. ↑ Kosikowska U, Korona-Głowniak I, Niedzielski A, Malm A (2015). "Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production". Medicine (Baltimore). 94 (18): e799. doi:10.1097/MD.0000000000000799. PMC 4602522. PMID 25950686.
  2. ↑ Rettig E, Tunkel DE (2014). "Contemporary concepts in management of acute otitis media in children". Otolaryngol. Clin. North Am. 47 (5): 651–72. doi:10.1016/j.otc.2014.06.006. PMC 4393005. PMID 25213276.
  3. ↑ Parlea E, Georgescu M, Calarasu R (2012). "Tympanometry as a predictor factor in the evolution of otitis media with effusion". J Med Life. 5 (4): 452–4. PMC 3539835. PMID 23346249.
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